Minimal Change Chronic Pancreatitis Research Articles

EUS and secretin endoscopic pancreatic function test predict evolution to overt structural changes of chronic pancreatitis in patients with nondiagnostic baseline imaging.

Background and Objectives:The accuracy of EUS and endoscopic pancreatic function test (ePFT) for diagnosis of early or minimal-change chronic pancreatitis (MCCP) is poorly understood. We hypothesized that the natural history of the disease may be used as a “gold standard” to assess the ability of EUS and ePFT to predict the eventual development of overt chronic pancreatitis (CP) changes on computed tomography/magnetic resonance cholangiopancreatography (CT/MRCP). The aim of the study was to determine the ability of EUS and ePFT to predict disease progression in patients with suspected MCCP who had nondiagnostic baseline imaging.Methods:A retrospective cohort study was conducted. Patients who underwent EUS and ePFT for suspected CP and who had nondiagnostic CT or MRCP were included. Patients without repeat imaging performed more than 1 year after their initial EUS/ePFT were excluded. Imaging was considered diagnostic if calcifications, main duct dilation (Cambridge Class III/IV), or severe atrophy were identified. Patients lost to follow-up were contacted to complete a survey documenting current symptoms and whether patients progressed to CP based on imaging. Univariable and multivariable analyses were performed using Cox regression.Results:Two hundred and thirty patients who underwent EUS/ePFT for suspected MCCP were identified between 2006 and 2012. Of these, 90 had a non-diagnostic baseline imaging test and subsequently a follow-up imaging test greater than 1 year later.These 90 patients constituted our study population. During a mean follow-up of 7 years, 19 (21%) patients developed CP by histology and imaging. Abnormal ePFT (peak bicarbonate <80 mmol) was a significant predictor of progression (hazard ratio [HR]: 4.7, confidence interval [CI]: 1.8, 12.4). Likewise, EUS Rosemont classification “suggestive/most-consistent” was a significant predictor of progression (HR: 7.3, CI: 2.4, 22.1).Conclusions:In patients with abdominal pain of suspected pancreatic origin and with nondiagnostic cross-sectional imaging, EUS and ePFT results predict the development of classic CP structural changes over time. These results support EUS and ePFT as effective tools for predicting progression of minimal change to overt CP.

EUS and secretin endoscopic pancreatic function test predict evolution to overt structural changes of chronic pancreatitis in patients with nondiagnostic baseline imaging

Background and Objectives: The accuracy of EUS and endoscopic pancreatic function test (ePFT) for diagnosis of early or minimal-change chronic pancreatitis (MCCP) is poorly understood. We hypothesized that the natural history of the disease may be used as a “gold standard” to assess the ability of EUS and ePFT to predict the eventual development of overt chronic pancreatitis (CP) changes on computed tomography/magnetic resonance cholangiopancreatography (CT/MRCP). The aim of the study was to determine the ability of EUS and ePFT to predict disease progression in patients with suspected MCCP who had nondiagnostic baseline imaging. Methods: A retrospective cohort study was conducted. Patients who underwent EUS and ePFT for suspected CP and who had nondiagnostic CT or MRCP were included. Patients without repeat imaging performed more than 1 year after their initial EUS/ePFT were excluded. Imaging was considered diagnostic if calcifications, main duct dilation (Cambridge Class III/IV), or severe atrophy were identified. Patients lost to follow-up were contacted to complete a survey documenting current symptoms and whether patients progressed to CP based on imaging. Univariable and multivariable analyses were performed using Cox regression. Results: Two hundred and thirty patients who underwent EUS/ePFT for suspected MCCP were identified between 2006 and 2012. Of these, 90 had a non-diagnostic baseline imaging test and subsequently a follow-up imaging test greater than 1 year later. These 90 patients constituted our study population. During a mean follow-up of 7 years, 19 (21%) patients developed CP by histology and imaging. Abnormal ePFT (peak bicarbonate <80 mmol) was a significant predictor of progression (hazard ratio [HR]: 4.7, confidence interval [CI]: 1.8, 12.4). Likewise, EUS Rosemont classification “suggestive/most-consistent” was a significant predictor of progression (HR: 7.3, CI: 2.4, 22.1). Conclusions: In patients with abdominal pain of suspected pancreatic origin and with nondiagnostic cross-sectional imaging, EUS and ePFT results predict the development of classic CP structural changes over time. These results support EUS and ePFT as effective tools for predicting progression of minimal change to overt CP.

EUS pancreatic function testing and dynamic pancreatic duct evaluation for the diagnosis of exocrine pancreatic insufficiency and chronic pancreatitis

EUS and endoscopic pancreatic function tests (ePFTs) may be used to diagnose minimal-change chronic pancreatitis (MCCP). The impact of evaluation for exocrine pancreatic insufficiency (EPI) and real-time assessment of EUS changes after intravenous secretin on the clinical diagnosis of MCCP is unknown. Patients with suspected MCCP underwent baseline EUS assessment of the pancreatic parenchyma and measurement of the main pancreatic duct (B-MPD) in the head, body, and tail. Human secretin 0.2 μg/kg was given intravenously followed 4, 8, and 12 minutes later by repeat MPD (S-MPD) measurements. Duodenal samples at 15, 30, and 45 minutes were aspirated to assess bicarbonate concentration. Endoscopists rated the percentage clinical likelihood of chronic pancreatitis (1) before secretin; (2) after secretin but before aspiration; and (3) after bicarbonate results. A total of 145 consecutive patients (mean age, 44±13 years; 98 females) were diagnosed with EPI (n= 32; 22%) or normal exocrine pancreatic function (n = 131, 78%). S-MPD/B-MPD ratios in the tail 4 and 8 minutes after secretin were higher in the group with normal exocrine function. Ratios at other times, locations, and duodenal fluid volumes were similar between the 2 groups. A statistically significant change in the median percentage likelihood of chronic pancreatitis was noted after secretin in all groups. The sensitivity and specificity of EPI for the EUS diagnosis of chronic pancreatitis (≥5 criteria) were 23.4% (95% confidence interval, 12.3-38.0) and 78.6% (95% confidence interval, 69.1-86.2), respectively. Real-time EUS findings and ePFTs have a significant impact on the clinical assessment of MCCP. The diagnosis of EPI shows poor correlation with the EUS diagnosis of MCCP. (Clinical trial registration number: NCT01997476.).

Alcohol excess and continued smoking are risk factors for progression from minimal change chronic pancreatitis to established chronic pancreatitis

Alcohol excess and continued smoking are risk factors for progression from minimal change chronic pancreatitis to established chronic pancreatitis

Sa2041 Predictors of Lymph Nodal Metastases With Resectable Pancreatic Adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed at an advanced stage. Breath testing is a non-invasive method that detects volatile organic compounds (VOCs). The aim was to identify VOCs that discriminate patients with PDAC from those with chronic pancreatitis (CP) and healthy controls. Methods: Blood was obtained from healthy controls (screening colonoscopy), severe CP (SCP, imaging demonstrating pancreatic calcifications), minimal change CP (MCCP, ≥4 standard endoscopic ultrasound (EUS) criteria and endoscopic pancreatic function testing peak bicarbonate <80 mEq), and PDAC (positive cytology obtained by EUS guided fine needle aspiration).Twenty milliliters of headspace was removed from the samples and analyzed for 22 VOCs by selected ion flow tube mass spectrometry. Analysis of variance was used to assess differences in VOC levels and receiver operating characteristic (ROC) analysis was performed to assess the role of VOCs in distinguishing PDAC from severe CP, MCCP and healthy controls. Results: 73 patients were included (20 healthy controls, 19 MCCP, 18 SCP and 16 PDAC). Adjusting for tobacco and alcohol usage, acetonitrile, ethanol, isoprene, 1-heptene, ammonia, ethane and triethyl amine were found to be associated with PDAC compared to all groups. ROC

Sa2040 Pancreatic Adenocarcinoma Is Associated With a Unique Spectrum of Serum Volatile Organic Compounds That Distinguishes It From Chronic Pancreatitis and Healthy Controls

Background: Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed at an advanced stage. Breath testing is a non-invasive method that detects volatile organic compounds (VOCs). The aim was to identify VOCs that discriminate patients with PDAC from those with chronic pancreatitis (CP) and healthy controls. Methods: Blood was obtained from healthy controls (screening colonoscopy), severe CP (SCP, imaging demonstrating pancreatic calcifications), minimal change CP (MCCP, ≥4 standard endoscopic ultrasound (EUS) criteria and endoscopic pancreatic function testing peak bicarbonate <80 mEq), and PDAC (positive cytology obtained by EUS guided fine needle aspiration).Twenty milliliters of headspace was removed from the samples and analyzed for 22 VOCs by selected ion flow tube mass spectrometry. Analysis of variance was used to assess differences in VOC levels and receiver operating characteristic (ROC) analysis was performed to assess the role of VOCs in distinguishing PDAC from severe CP, MCCP and healthy controls. Results: 73 patients were included (20 healthy controls, 19 MCCP, 18 SCP and 16 PDAC). Adjusting for tobacco and alcohol usage, acetonitrile, ethanol, isoprene, 1-heptene, ammonia, ethane and triethyl amine were found to be associated with PDAC compared to all groups. ROC

Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis

ObjectivesPatients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. MethodsAll patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. ResultsA total of 84 patients with a mean age of 36.5 years (range: 15–60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. ConclusionsThe present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.

Pancreatic juice prostaglandin e2 concentrations are elevated in chronic pancreatitis and improve detection of early disease.

Objectives:Chronic pancreatitis (CP) may be difficult to diagnose in early stages. We aimed to measure pancreatic juice (PJ) prostaglandin E2 (PGE2) concentrations to determine whether they are elevated in CP and improve diagnosis of early disease.Methods:We measured PJ PGE2 in 10 patients with established CP, 25 patients who met criteria for “minimal change” chronic pancreatitis (MCCP), and 10 normal control participants.Results:Median PJ PGE2 was elevated in CP (307 pg/ml, IQR (249–362)) and MCCP (568 pg/ml, (418–854)) compared with normal controls (104 pg/ml, (68–206)) (P≤ 0.001). Area under receiving operator curve (AUROC) for diagnosis of CP and MCCP was 0.9 and 0.62, respectively, for PJ bicarbonate concentration alone; AUROC was 1.0 and 0.94 for the combination of PJ bicarbonate and PGE2 concentrations.Conclusions:PJ PGE2 appears to be a biomarker for CP and is elevated in both established and “minimal change” chronic pancreatitis.

Cost-Effectiveness of Total Pancreatectomy and Islet Cell Autotransplantation for the Treatment of Minimal Change Chronic Pancreatitis

IntroductionThe current standard of care for the management of minimal change chronic pancreatitis (MCCP) is medical management. Controversy exists, however, regarding the use of surgical intervention for MCCP. We hypothesized that total pancreatectomy and islet cell autotransplantation (TPIAT) decreases long-term resource utilization and improves quality of life, justifying initial costs and risks. MethodsDetailed perioperative outcomes from 46 patients with MCCP populated a Markov model comparing medical management to TPIAT. Mortality, complications, readmission rates, insulin and narcotic use, imaging, and endoscopy were included in the model. Outcomes reported were survival, measured in quality-adjusted life years (QALYs), and costs, in 2013 US dollars. ResultsIn medical patients, annual mean hospital admissions were 1.6 (range = 0–11), endoscopy 1.4 (0–6), and imaging (CT/MRI) 1.5 (0–4). In surgical patients, there were no perioperative deaths, with complication and 30-day readmission rates of 47 and 37 %. One year after TPIAT, annual mean admissions, endoscopy, and imaging had decreased to 0.9 (0–4), 0.4 (0–2), and 0.9 (0–5); monthly narcotic use decreased from 138 to 37 morphine equivalents (p = 0.012). Cost and survival for TPIAT versus medical management were $153,575/14.9 QALYs and $196,042/11.5 QALYs, respectively. ConclusionsIn patients with MCCP, TPIAT is associated with decreased cost and increased quality-adjusted survival. Providers and insurers should more enthusiastically embrace TPIAT use as a more effective cost-saving strategy.

Early Minimal Change Chronic Pancreatitis” Or “Imaging Negative Chronic Pancreatitis

We report five cases of or minimal change pancreatitis in our outpatient department. Minimal Change Pancreatitis is an entity that is very unfamiliar in majority of the practicing physician & surgeons. It is often called as early chronic pancreatitis. All these terms are often used synonymously. It is a syndrome consisting of phase of inflammation of pancreas which is manifested by less easily identifiable clinical features like chronic or recurrent abdominal pain syndrome with normal abdominal imaging studies e.g. USG (Ultrasonography), CT (Computed Tomography),MRI(Magnetic Resonance Imaging)/MRCP(Magnetic Resonance Cholangio Pancreatography).

818 Pancreatic Juice Prostaglandin E2 Levels Are Elevated in Minimal Change Chronic Pancreatitis and Correlate With Endoscopic Ultrasound Findings

818 Pancreatic Juice Prostaglandin E2 Levels Are Elevated in Minimal Change Chronic Pancreatitis and Correlate With Endoscopic Ultrasound Findings

Abnormal Duodenal [HCO3 −] Following Secretin Stimulation Develops Sooner Than Endocrine Insufficiency in Minimal Change Chronic Pancreatitis

Direct pancreatic function tests (PFTs) are often used to diagnose chronic pancreatitis (CP). We aimed to determine the temporal relationship between an abnormal PFT result, cross-sectional imaging, and clinical symptoms. All patients referred for endoscopic ultrasound (EUS) and PFT for suspected CP at our medical center from 2008 to 2010 were included. Each subject underwent EUS and PFT on the same day using secretin stimulation. Seventeen patients had duodenal HCO3 values of less than 80 mEq/L and were labeled as abnormal; the 25 other patients had at least 1 duodenal HCO3 values of 80 mEq/L or greater. Patients with abnormal PFTs had more parenchymal (2.0 vs 0.92, P = 0.012), ductal (1.18 vs 0.6, P = 0.036), and total features (3.18 vs 1.52, P = 0.009) than those with normal PFTs on EUS examination. There was no difference in regard to the frequency of abnormal CT scans (25% vs 15%, P = 0.139), diarrhea (67% vs 60%, P = 0.463), fat-soluble vitamin deficiency (33% vs 26%, P = 0.315), or diabetes (10% vs 4%, P = 0.066). Patients with equivocal imaging and abnormally low duodenal HCO3 have more EUS features of CP than do patients with normal duodenal HCO3 values, suggesting that low duodenal HCO3 values are among the first measurable abnormalities in CP.

Endoscopic ultrasonography to evaluate pancreatitis

Endoscopic ultrasonography (EUS) has become a well-accepted test in the workup of acute and chronic pancreatitis. However, further studies are needed to define its diagnostic role in patients with recurrent acute pancreatitis and minimal-change chronic pancreatitis.

Correlation of ePFT and EUS to Histology: Were These Really Minimal Change Chronic Pancreatitis Patients?

Correlation of ePFT and EUS to Histology: Were These Really Minimal Change Chronic Pancreatitis Patients?

Correlation Between EUS and Histopathology in 50 Patients Undergoing Total Pancreatectomy (TP) with Islet Autotransplantion (IAT) for Minimal Change Chronic Pancreatitis (MCCP): ACG Auxiliary Award

Purpose: Diagnosis of minimal change (non-calcific) chronic pancreatitis (MCCP) is challenging and controversial. Endoscopic ultrasound (EUS) has been widely used for diagnosing MCCP using 9 standard criteria, however, these criteria are derived from correlation between EUS and histology from patients (pts) undergoing resection for conditions other than MCCP. The aim of our study was to investigate the correlation between EUS findings and histopathology in pts undergoing total pancreatectomy with islet autotransplantation (TP-IAT) for painful MCCP. Methods: We retrospectively compared EUS findings (obtained <1 year prior to surgery) with histopathology of the pancreas in 50 adults and children with MCCP (no calcifications on abdominal CT) from a total of 141 pts undergoing TP-IAT at a single center from 1/2008 through 7/2010. EUS abnormalities were classified using 9 standard criteria. Pts were selected for TP-IAT by a multidisciplinary committee based on intractable disabling pancreatic pain, absence of correctable etiology, refractory to maximal endoscopic therapy, plus MCCP based on the following criteria: documented history of acute recurrent pancreatitis, or abnormality in at least 2 of the following 3 tests: 1) EUS (≥4/9 criteria), 2) secretin stimulated MRCP with ductographic abnormalities or decreased T1 parenchymal signal, 3) abnormal endoscopic pancreatic function test (peak bicarbonate concentration <80 mM/L). Histology was obtained from resected pancreas by wedge biopsy of head, body and tail when possible (mean # of biopsies 2.6). Histopathology was evaluated by a blinded pancreas pathologist. MCCP was determined as present histologically when fibrosis, atrophy or inflammation was found in at least one post resection biopsy. Results: MCCP using composite of any of 3 abnormalities was found at histopathology in 45/50 (90%) pts. All 45 (100%) pts had fibrosis. The 5 pts (10%) with normal histology all had a documented history of acute recurrent pancreatitis in addition to disabling pain. Of pts with histologically confirmed MCCP, 27/45 (60%) had ≥4/9 criteria on EUS. 18/21 (85%) pts with ≤3 EUS criteria and 4/5 (80%) pts with 0/9 EUS criteria had both fibrosis and MCCP by histopathology. 2/29 (7%) pts with ≥4/9 EUS criteria had normal histology. AUC was 0.593, Kappa Coefficients <0.11 for all cutoff points. Negative predictive value of a normal EUS was only 38%, and positive predictive value of abnormal EUS only exceeded 72% at ≥6 criteria. Conclusion: Correlation between EUS and histopathology of minimal change chronic pancreatitis is poor in pts undergoing TP-IAT. Normal or nearly normal EUS cannot be used to exclude MCCP, and abnormal EUS alone is probably not sufficient for the diagnosis unless ≥6 criteria are present.

Mo1377 Correlation of EUS With Histopathology in 50 Patients Undergoing Total Pancreatectomy (TP) With Islet Autotransplantion (IAT) for Minimal Change Chronic Pancreatitis (MCCP)

Diagnosis of minimal change (non-calcific) chronic pancreatitis (MCCP) is challenging and controversial. Endoscopic ultrasound (EUS) has been widely used for diagnosing MCCP using 9 standard criteria, which are based partly on correlation between EUS and histology from patients (pts) undergoing resection for conditions other than MCCP. The aim of our study was to investigate the correlation between EUS findings and histopathology in pts undergoing total pancreatectomy with islet autotransplantation (TP-IAT) for painful MCCP.

A case of portal vein thrombosis caused by ingestion of a foreign body

Aspiration pneumonia developed in patient 3 after secretin administration. The patient was observed vomiting immediately before her episode of oxygen desaturation. Moreover, the left-sided distribution of the pneumonia is suggestive of aspiration because the patient was in a left-lateral decubitus position during the procedure. A copious amount of pancreatic fluid was visualized from the ampulla after secretin stimulation (Video 1, available online at www.giejournal.org). In our experience, a rapid squirting of pancreatic fluid from the papilla is often observed in patients with a normal pancreas. This can reflux through the pylorus and increase the risk of aspiration. Although this may be an isolated incident, preventive measures such as elevating the head of the bed should be implemented. The stomach should be aggressively suctioned before secretin injection and monitored throughout the procedure. Secretin was previously thought to be a benign agent with minimal concern for adverse events. Given the outcomes of the cases reported here, endoscopists using this secretagogue should be aware of potential adverse outcomes. Consideration of ePFT in patients with no discernable features of chronic pancreatitis on EUS should be carefully scrutinized regarding the potential risks and benefits, along with the pretest probability for minimal change chronic pancreatitis.

Abnormal Duodenal [HCO3-] Following Secretin Stimulation Develops Sooner than Endocrine Insufficiency in Minimal Change Chronic Pancreatitis

Abnormal Duodenal [HCO3-] Following Secretin Stimulation Develops Sooner than Endocrine Insufficiency in Minimal Change Chronic Pancreatitis

Combined Endoscopic Ultrasound and Secretin Endoscopic Pancreatic Function Test in Patients Evaluated for Chronic Pancreatitis

Endoscopic ultrasound and endoscopic secretin pancreatic function test may be combined in a single endoscopic session (EUS/ePFT) to diagnose chronic pancreatitis (CP). Our primary aim was to assess the correlation and concordance of combined EUS and secretin ePFT bicarbonate results in suspected minimal change CP. Radial EUS included scoring for nine criteria (normal<4 criteria) with endoscopic collection of duodenal samples at 15, 30, and 45 min after secretin stimulation (normal peak bicarbonate>or=80 mmol/l). Three hundred and two patients completed the EUS/ePFT (252 for suspected minimal change CP, 38 for established CP, 12 for painless steatorrhea). In patients evaluated for suspected minimal change CP, a moderate negative correlation was observed between endoscopic ultrasound score and peak bicarbonate (r=-0.38, P<0.001). The EUS and ePFT results were 76% concordant and 24% discordant. The ePFT was 85% sensitive and EUS was 100% sensitive for detecting patients with established calcific CP. The EUS/ePFT diagnosed CP in two of 12 of patients evaluated for painless steatorrhea or diarrhea with weight loss. The combined EUS/ePFT is feasible and safe. There is only moderate correlation and concordance of endoscopic ultrasound and endoscopic pancreatic function test results in patients with suspected minimal change CP. The EUS and ePFT results produce complimentary functional and structural information for the evaluation of CP.

Comparison of the Accuracy of Standard and Rosemont Endoscopic Ultrasound (EUS) Scoring for the Diagnosis of Chronic Pancreatitis (CP)

Introduction: The Rosemont classification has been developed to improve the EUS diagnosis of CP. The accuracy of Rosemont scoring compared with standard scoring is not known. Aim: To compare the ability of Rosemont and standard scoring to accurately classify patients with and without chronic pancreatitis (CP). Methods: EUS videos were independently read on 2 occasions by 14 experts: First, the videos were read using standard scoring (9 criteria). Second, after viewing a presentation of the Rosemont Classification, the same experts re-read the videos using Rosemont scoring. The standard and Rosemont interpretations were compared with a composite reference standard, based on risk factors (RF, acute pancreatitis, alcohol, SOD, pancreas divisum, high triglycerides, and genetic mutations), secretin pancreatic function test (PFT) results, and CT findings. The videos were assigned in 4 groups: 1. No CP (n=3): No pain, no RF, normal CT, 2. CP unlikely (n=11): Pain, no RF, nl CT, nl PFT, 3. Minimal change CP (n=4): Pain, RF present, normal CT, abnl PFT, 4. Definite CP (n=13): diagnostic CT (calcifications, duct dilation, atrophy). Results: 434 interpretations were included (14 experts x 31 videos). Two analyses were performed: The first analysis included pts with definite absence or presence of CP (groups 1 and 4): Standard scoring correctly classified group 1 pts as "normal" (<3 criteria) in 27/42 interpretations and "indeterminate" (3 or 4 criteria) in 13/42 (total 96%). Rosemont scoring correctly classified pts as "normal" in 28 and "indeterminate" in 12 (total 96%). Standard scoring correctly classified pts in group 4 as "abnormal" (≥5 criteria) in 138/182 interpretations (76%). Rosemont correctly classified these pts as "most consistent" in 113 and "suggestive" in 39 (total 83%). The second analysis included pts in all 4 groups: Standard scoring classified pts in group 1 and 2 as "normal" 108/196 times and "indeterminate" 75/196 times (total 93%). Rosemont scoring classified pts as "normal" 133 times and "indeterminate" 47 times (total 92%). Standard scoring classified pts in groups 3 and 4 as abnormal 156/238 times (66%). Rosemont classified these pts as "most consistent" 129 times and "suggestive" 47 times (total 74%). Conclusions: 1. Both scoring systems correctly classify patients without CP as "normal" or "indeterminate" in more than 90% of interpretations (high specificity for both). 2. Rosemont correctly classified patients with CP slightly more often than standard scoring. 3. The performance of both scoring systems decrease when patients with suspected minimal change CP are included.